Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death for children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rear-facing car safety seats as long as possible; (2) forward-facing car safety seats from the time they outgrow rear-facing seats for most children through at least 4 years of age; (3) belt-positioning booster seats from the time they outgrow forward-facing seats for most children through at least 8 years of age; and (4) lap and shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health supervision visit.
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. In 2020, firearms resulted in 10,197 deaths (fatality rate 9.91/100,000 youth 0-24 years old). Firearms are the leading mechanism of death in pediatric suicides and homicides. Increased access to firearms is associated with increased rates of firearm deaths. Substantial disparities in firearm injuries and deaths exist by age, gender, race, ethnicity, and sexual orientation and gender identity and for deaths related to legal intervention. Barriers to firearm access can decrease the risk to youth for firearm suicide, homicide, or unintentional shooting injury and death. Given the high lethality of firearms and the impulsivity associated with suicidal ideation, removing firearms from the home or securely storing them-referred to as lethal means restriction of firearms-is critical, especially for youth at risk for suicide. Primary care-, emergency department-, mental health-, hospital-, and community-based intervention programs can effectively screen and intervene for individuals at risk for harming themselves or others. The delivery of anticipatory guidance coupled with safety equipment provision improves firearm safer storage. Strong state-level firearm legislation is associated with decreased rates of firearm injuries and death. This includes legislation focused on comprehensive firearm licensing strategies and extreme risk protection order laws. A firm commitment to confront this public health crisis with a multipronged approach engaging all stakeholders, including individuals, families, clinicians, health systems, communities, public health advocates, firearm owners and nonowners, and policy makers, is essential to address the worsening firearm crisis facing US youth today.
This new compendium contains an AAP clinical practice guideline, policy statements, clinical reports, and technical reports related to the prevention of injuries in and violence toward the pediatric population.https://shop.aap.org/injury-and-violence-prevention-a-compendium-of-aap-clinical-practice-guidelines-and-policies-pape/
Children with special health care needs should have access to proper resources for safe transportation as do typical children. This policy statement reviews important considerations for transporting children with special health care needs and provides current guidance for the protection of children with specific health care needs, including those with airway obstruction, orthopedic conditions or procedures, developmental delays, muscle tone abnormalities, challenging behaviors, and gastrointestinal disorders.
An inherent tension exists in clinical training between supervising learners to ensure quality and patient safety, and allowing learners to practice independently to gain experience. In this issue of Academic Medicine, Biondi and colleagues discuss this tension, highlighting the disconnect between faculty and resident perceptions of autonomous practice for housestaff. They report that each group perceives itself as more competent in its role than does the other group. Their work leads us to consider how medical educators might safely and effectively transform the learning process. Self-determination theory (SDT) holds that there is a human tendency to develop toward self-directed and autonomous regulation of behavior. This development of intrinsic motivation is governed by the complex relationships among autonomy, competence, and relatedness as well as educational content and the learning milieu. Applying an SDT framework to their findings, Biondi and colleagues report that faculty desire from residents the evidence of internal motivation and demonstration of competence and self-confidence that will allow faculty to entrust learners with autonomy. They conclude, however, that these are qualities that faculty find lacking in many residents. To optimize the balance between autonomy and supervision, this Commentary's author proposes the use of "scaffolding," a construct from developmental psychology. In the scaffolding model, the role of teachers is to support the learner's development and to provide support structures to help the learner get to the next stage of entrustment and competence. Achieving a balance is essential to providing the best patient care now and in the future.
BACKGROUND Safety centers (SCs) are hospital-affiliated outlets that provide families with safety products and personalized education about preventing injuries. Roughly 40 SCs are in operation across the United States, but no single model for staffing, supplying, or sustaining them has emerged. The project aimed to determine the feasibility of a centralized database for SC evaluation as the first step toward growing this proven intervention. METHODS An Expert Advisory Committee was convened to determine data collection elements and procedures. Representatives from nine hospital-based SCs collected data about car seat and bike helmet sales and education provided between August 1, 2013, to December 31, 2013. RESULTS A total of 645 study-related safety products were distributed at cost (72%), below cost (10%), or for free (19%). Education was provided for 96% of all products distributed, including receipt of print materials (81%) and product demonstrations (83%). Visitors to SCs were usually referred by a hospital provider (34%), followed by word of mouth (24%) and walk-in (22%). Seven of nine SCs were able to contribute data. Stability of SCs and capacity of staff emerged as facilitators of centralized data collection feasibility. CONCLUSION We demonstrate that centralized data collection is feasible and that information to compare centers can be obtained. However, for more meaningful comparisons to emerge and to enable all SCs the ability to participate, support is needed institutionally for staff to be able to capture data and nationally to grow and sustain a database that represents the broader diversity of topics and services offered.
Advocacy is at the heart of pediatrics and neonatal care. Historically and currently, numerous pediatricians have used their expertise to raise the voices of children and families to promote child health and welfare. Despite a lack of formal training in advocacy and health policy, many of the skills required for daily clinical care can, and ought to, be applied to affect systemic change within neonatology. Advocacy can no longer be considered an optional activity, but rather a core competency and professional responsibility. In this review, the authors describe the necessity and foundational principles for advocacy success as well as provide guidance, resources, and opportunities for neonatologists and clinicians providing newborn care.
Since 1999, the American Academy of Pediatrics (AAP) has asserted that pediatricians should “reaffirm their role as professionals in the community and prepare themselves for it, just as diligently as they prepare for traditional clinical roles.” (1) Furthermore, as of 2001, the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Pediatrics mandated, “there must be structured educational experiences that prepare residents for the role of advocate for the health of children within the community.” (2) As with clinical responsibilities, the best approach to preparing for such a role is with active hands-on learning. Accomplishing this task generally means participating in a community-based project or other activity.Fortunately, the skills gained during project participation translate smoothly into ACGME competencies. The Table illustrates how this teaching can be accomplished by using, as an example, one of the projects highlighted in this series. The Children's Hospital of Philadelphia pediatric residents have engaged in Ballroom Dance for L.I.F.E. to increase physical activity for inner city fifth graders. (3) This endeavor not only allowed the residents to serve the community but also helped them to attain numerous proficiencies. Faculty review of this project, with recording of feedback, progress, and outcome, fulfills the documentation needs for ACGME competencies of medical knowledge, interpersonal and communication skills, professionalism, and systems-based practice.The AAP Community Pediatrics Training Initiative (CPTI), in its Structured Approach to Community Health and Child Advocacy Training: Integrating Goals, Activities, and Competencies, has identified educational goals and objectives to help frame all community pediatrics experiences while also meeting requirements of the ACGME. This document and additional resources are available on the CPTI web site: http://www.aap.org/commpeds/CPTI. This approach is based on the work published in a supplement to Pediatrics in 2005 by the Dyson Initiative curriculum committee. (4) The CPTI workgroup (5) identified eight domains of community pediatrics practice: For each domain, a goal and three to six specific objectives are listed in a table with sample activities and documentation, as well as corresponding ACGME competencies. The Table in this article presents one domain as an example. We believe that community pediatrics eventually will become an integral part of pediatric training.Dr Albert Schweitzer, the great medical humanitarian, said, “Example is not the main thing in influencing others, it is the only thing.” I hope that the stories highlighted in this section to date have been inspirational. The challenge going forward will be to multiply such examples systematically so they become the norm rather than the exception. This article points out that achieving this result requires integrating community pediatrics into the routine processes of residency training. Documenting what residents learned by teaching children to waltz is not yet as simple as 1, 2, 3, but it perhaps just became easier. (C. Andrew Aligne, MD,MPH)
Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States. They are also an important cause of injury with long-term physical and mental health consequences. A multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth. Interventions should be focused on the individual, household, community, and policy level. Strategies for harm reduction for pediatric firearm injuries include providing anticipatory guidance regarding the increased risk of firearm injuries and deaths with firearms in the home as well as the principles of safer firearm storage. In addition, lethal means counseling for patients and families with individuals at risk for self-harm and suicide is important. Community-level interventions include hospital and community-based violence intervention programs. The implementation of safety regulations for firearms as well as enacting legislation are also essential for firearm injury prevention. Increased funding for data infrastructure and research is also crucial to better understand risks and protective factors for firearm violence, which can then inform effective prevention interventions. To reverse this trend of increasing firearm violence, it is imperative for the wider community of clinicians, public health advocates, community stakeholders, researchers, funders, and policy makers to collaboratively address the growing public health crisis of firearm injuries in US youth.
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